Attention-Deficit Hyperactivity and Obsessive-Compulsive Symptoms in Adult Patients With Primary Restless Legs Syndrome: Different Phenotypes of the Same Disease?

OBJECTIVES: To investigate the prevalence of attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) symptoms in adult patients with primary restless legs syndrome (RLS) and to determine the iron biological correlates of these comorbidities. PARTICIPANTS AND METHODS: We obtained demographic and clinical data from consecutive 105 outpatients with idiopathic RLS who answered validated questionnaires designed to assess the presence of ADHD and OCD symptoms. In these patients, iron blood parameters were routinely checked. RESULTS: Of the total sample, 42.86% of the patients with RLS showed symptoms reminiscent either of ADHD or OCD. Prevalence of ADHD and OCD symptoms was 27.62% and 7.62%, respectively. Compared to other groups, a significantly higher percentage of RLS patients with ADHD symptoms was on antidepressant (p = 0.012); and women with ADHD symptoms, either alone or combined with OCD symptoms, showed significant reduced ferritin concentrations compared to men with either isolated ADHD symptoms or with combined ADHD and OCD symptoms (p = 0.028 and p = 0.025, respectively). CONCLUSIONS: Our findings highlight the high prevalence of ADHD and OCD symptoms in adult patients with primary RLS and independently of serum iron stores decrease, except for women with ADHD symptoms either alone or in combination with OCD symptoms. This may suggest an overlapping neurobiological dopaminergic and serotoninergic dysfunction in ADHD, OCD, and RLS, and question the expression of different RLS phenotypes. The efficacy of dopamine agonists in these groups of patients should be questioned in future studies.

Activity/rest cycle and disturbances of structural backbone of cerebral networks in aging.

OBJECTIVE: Although aging is associated with alterations of both activity/rest cycle and brain structure, few studies have evaluated associations between these processes. The aim of this study was to examine relationship between activity/rest cycle quality and brain structural integrity in aging subjects by exploring both grey and white matter compartments. MATERIAL AND METHODS: Fifty-eight elderly subjects (76±0.5 years; 41% female) without dementia, sleep disorders and medications were included in the analysis. Actigraphy was used to measure parameters of activity/rest cycle (24-h amplitude, 24-h fragmentation and 24-h stability) and sleep (total sleep time and sleep fragmentation) over a minimal period of 5 days. Whole brain linear regression analyses were performed on grey matter volumes maps using voxel based morphometry and on white matter integrity using tract based statistics analyses. RESULTS: A lower 24-h amplitude and a higher sleep fragmentation were independently associated with a reduction of white matter integrity in models including age and gender as covariates. The association between 24-h amplitude and white matter integrity decreased but remained significant in a model accounted for sleep fragmentation, indicating a specific effect of 24-h cycle disturbances. No association with grey matter volumes was observed. CONCLUSION: In elderly, not only sleep but also 24-h cycle disturbances were associated with altered structural connectivity. This alteration of structural backbone networks related to activity/rest cycle disturbances in aging might constitute a cerebral frailty factor for the development of cognitive impairment.

Affective Prosody and Depression After Stroke: A Pilot Study.

BACKGROUND AND PURPOSE: Poststroke depression (PSD) is a frequent complication of stroke with detrimental consequences in terms of quality of life and functional outcomes. In individuals with major depression, several studies have demonstrated an alteration of affective prosody. The aim of this study is to identify prosodic markers that may be predictive of PSD. METHODS: Patient voices were recorded at baseline and 3 months after stroke. We extracted prosodic parameters, including fundamental frequency, percentage of voice breaks, and shimmer. Depression and anxiety symptoms were assessed 3 months later. RESULTS: Among the 49 patients included in the study, 22.5% developed PSD 3 months after stroke. A significant decrease was observed concerning the fundamental frequency among patients who developed PSD. Discriminant analysis demonstrated that initial voice breaks coupled with shimmer are strongly predictive of subsequent PSD. CONCLUSIONS: Early alterations of affective prosody are associated with a higher risk of PSD 3 months after a stroke. This new physiological approach overcomes traditional barriers associated with clinical instruments and contributes to the prediction of this disorder.

Improvement of in vivo quantification of [123I]-Iodobenzovesamicol in single-photon emission computed tomography/computed tomography using anatomic image to brain atlas nonrigid registration.

Brain anatomy variability is a major problem in quantifying functional images in nuclear medicine, in particular relative to aging and neurodegenerative diseases. The aim of this study was to compare affine and elastic model-based methods for magnetic resonance imaging (MRI) to brain atlas registration and to assess their impact on the quantification of cholinergic neurotransmission. Patients with multiple system atrophy (MSA) and age-matched healthy subjects underwent an MRI and a single-photon emission computed tomographic (SPECT) examination using [123I]-iodobenzovesamicol (IBVM). Both affine and elastic methods were compared to register the subjects' MRI with the Montreal Neurological Institute brain atlas. Performance of the registration accuracy was quantitatively assessed and the impact on the IBVM quantification was studied. For both subject groups, elastic registration achieved better quantitative performance compared to the affine model. For patients suffering from neurogenerative disease, this study demonstrates the importance and relevance of MRI to atlas registration in quantification of neuronal integrity. In this context, in comparison with rigid registrations, an elastic model-based registration provides the best relocation of the brain structures to the atlas for accurately quantifying cholinergic neurotransmission.

Night-to-night variability in sleep and amyloid beta burden in normal aging.

INTRODUCTION: Alzheimer's disease is associated with sleep disturbances and accumulation of cerebral amyloid beta. The objective was to examine whether actigraphy-detected sleep parameters might be biomarkers for early amyloid burden. METHODS: Participants underwent a week of actigraphy and an amyloid positron emission tomography (PET) scan. Sleep duration and continuity disruption (sleep fragmentation and nocturnal awakenings) were extracted and compared between amyloid-positive and amyloid-negative participants. Then multiple linear regressions were used between mean or night-to-night intra-individual variability (standard deviation) of sleep parameters and brain amyloid burden in a voxel-wise analysis. RESULTS: Eighty-six subjects were included (80.3 ± 5.4 years; 48.8% of women). Amyloid-positive participants had a higher variability of sleep fragmentation compared to amyloid-negative participants. This parameter was associated with a higher amyloid burden in the frontal and parietal regions, and in the precuneus, in the whole sample. DISCUSSION: This study highlights the relevance of using variability in sleep continuity as a potential biomarker of early amyloid pathogenesis.

Progressive supranuclear palsy: in vivo SPECT imaging of presynaptic vesicular acetylcholine transporter with [123I]-iodobenzovesamicol.

PURPOSE: To evaluate the integrity of brain cholinergic pathways in vivo in patients with progressive supranuclear palsy (PSP) by measuring the vesicular acetylcholine transporter expression at single photon emission computed tomography (SPECT) with [123I]-iodobenzovesamicol. MATERIALS AND METHODS: All participants provided informed written consent according to institutional human ethics committee guidelines. Ten patients with PSP and 12 healthy volunteers underwent dynamic [123I]-iodobenzovesamicol SPECT and magnetic resonance (MR) imaging. CT and MR images were used to register the dynamic SPECT image to the Montreal Neurologic Institute brain template, which includes the regions of interest of the striatum and the septo-hippocampal, innominato-cortical, and ponto-thalamic cholinergic pathways. For each region of interest, pharmacokinetic modeling of regional time activity curves was used to calculate [123I]-iodobenzovesamicol to vesicular acetylcholine transporter binding potential value, proportional to vesicular acetylcholine transporter expression. RESULTS: When compared with control participants, patients with PSP had binding potential values that were unchanged in the striatum and septohippocampal pathway, significantly lower in the anterior cingulate cortex (P=.017) in the innominatocortical pathway, and significantly decreased in the thalamus (P=.014) in the pontothalamic cholinergic pathway. In addition, binding potential values in the thalamus were positively correlated with those in the pedunculopontine nucleus (ρ=0.81, P<.004) and binding potential values in both the thalamus (ρ=-0.88, P<.001) and pedunculopontine nucleus (ρ=-0.80, P<.010) were inversely correlated with disease duration. CONCLUSION: Cholinergic pathways were differentially affected in the PSP group, with a significant alteration of pontothalamic pathways that increased with disease progression at both cell body and terminal levels, while the innominatocortical pathway was only mildly affected, and the septohippocampal pathway and the striatum were both preserved.

Attention-deficit/hyperactivity and obsessive-compulsive symptoms in adult patients with primary restless legs syndrome.

Comorbidity between Restless Legs Syndrome and Attention-Deficit/Hyperactivity Disorder remains a matter of debate. This putative association, possibly reflecting a shared brain iron homeostasis and dopaminergic dysfunction, supports the hypothesis of a neurodevelopmental component in Restless Legs Syndrome pathogenesis. The aim of this study was to investigate Attention-Deficit/Hyperactivity Disorder and Obsessive-Compulsive Disorder symptoms prevalence in adult patients with primary Restless Legs Syndrome compared to another ill group of patients with obstructive sleep apnea syndrome to control for the disease specific effects on psychiatric symptoms and a healthy individuals control group. Clinical data were obtained through standardized and validated self-administrated questionnaires evaluating Attention-Deficit/Hyperactivity Disorder and Obsessive-Compulsive Disorder symptoms frequencies in 139 outpatients with idiopathic Restless Legs Syndrome, 111 patients with treated obstructive sleep apnea syndrome and 136 healthy subjects. Our findings demonstrate a higher prevalence of Attention-Deficit/Hyperactivity Disorder symptoms among both male and female patients with Restless Legs Syndrome, compared to obstructive sleep apnea syndrome patients and healthy subjects (33.3 and 43.5%, respectively, p < 0.001). Only women presented a strong relationship between Attention-Deficit/Hyperactivity Disorder and Restless Legs Syndrome severity (p < 0.001). Male and female in the three groups showed similar Obsessive-Compulsive Disorder symptom prevalence. These findings indicate that Attention-Deficit/Hyperactivity Disorder symptoms among adult patients with Restless Legs Syndrome populations are a robust phenomenon. These data provide arguments in favor of an enlargement of the clinical neuropsychological presentation of Restless Legs Syndrome and question the role of decreased brain iron of these psychiatric symptoms.

Age-related positivity effect: Distinct mechanisms for lexical access and episodic memory of emotional words.

The age-related positivity effect is the tendency of older adults to preferentially process positive information over negative information when compared to younger adults (e.g., Reed & Carstensen, 2012). The aim of the study was to determine whether common and/or distinct mechanisms underlie the age-related positivity effect in lexical access and episodic memory. Fifty young and 50 older adults successively performed a progressive demasking task incorporating memory instructions, an immediate free recall task, a memory recognition task, and delayed free recalls at 20 min and 7 days. The materials included 60 words that varied in emotional valence (positive, neutral, negative) and arousal (low, high). The results revealed that distinct processes underlie the age-related positivity effect in lexical access and episodic memory. In progressive demasking, this effect emerged for both low- and high-arousal words, suggesting that it depends on automatic processes. In immediate and delayed free recall and recognition, this effect emerged for low-arousal words only, suggesting that it depends on more controlled processes. Moreover, in older adults, positivity scores correlated with well-being scores for episodic memory. These results are discussed in relation to affective aging theories. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Assessment of dream-related aspects and beliefs in a large cohort of French students using a validated French version of the Mannheim Dream questionnaire.

Focusing on a specific population when studying dream characteristics can shed light on underlying mechanisms and correlates of dreaming. The aim of this study is to establish a clearer description of specific dream aspects and beliefs in a large cohort of students using a validated questionnaire, and to further investigate the role of sociodemographic variables such as age, gender and field of study. Participants were 1137 students aged from 18 to 34 (mean age: 22.2) who responded to an online version of the questionnaire. Our results showed a difference between humanities and science students, and a differential effect of gender on dream variables. Our results are discussed in light of previous investigations using the same questionnaire or focusing on the same population.

The age-related positivity effect: forgetting the negative and/or remembering the positive? An inter-task study.

A growing number of studies have shown that when compared to younger adults, older adults are better at recalling positive information than negative information. However, it is not yet clear whether this age-related positivity effect relies on a greater ability to recall positive information or on a decreased ability to recall negative information. We therefore aimed to study the specific mechanisms underlying the age-related positivity effect using different memory tasks. We used an emotional word memory paradigm including immediate free recall, recognition, and delayed free recall tasks. Forty-five young adults (m = 20.0 years) and 45 older adults (m = 69.2 years) participated, all of whom were native French speakers. Thirty-six French low-arousal words (12 positve, 12, negative, 12 neutral) were selected from an emotional lexical database (Gobin et al. 2017) and divided into three equal groups of positive, neutral and negative terms. For the recognition task, 36 new words were selected. The results show that the age-related positivity effect specifically depended on a decrease in negativity preference (i.e., the comparison between negative and neutral words) in older adults, in comparison with younger adults, both in the immediate and delayed free recall tasks. In these tasks, younger adults recalled more negative than neutral words, whereas there was no difference in older adults. During the recognition task, no age-related positivity effect was observed. The results also show that, for the immediate recall task, the greater the memory ability of older adults, the lower their negativity preference. This correlation was not significant in the delayed recall task. These results suggest that, when compared with younger adults, older adults disengage from processing negative words that require costly cognitive processes. A low negativity preference indicates that memory abilities are well-maintained. The results are discussed within the framework of socio-emotional selectivity theory.

Paradoxical effect of severe dietary restriction on Long-Evans rat life span.

It has been firmly established that the longevity of 20- to 60%-calorie-restricted rodents, with malnutrition (essential nutrients deficiency) being avoided, is increased when compared to ad libitum fed rodents. However, the effects on life span of severe dietary restriction (i. e. malnutrition), with limited weight loss, remained unknown. The purpose of this 4-year study was to investigate the effects on longevity of a severe form of dietary restriction, with limited and controlled weight loss. To this end, a group of male Long-Evans rats severely dietary restricted (SDR group), with a weight loss throughout the experiment

[The age-related positivity effect: forgetting the negative and/or remembering the positive? An inter-task study]. / L'effet de positivité lié à l'âge : oublier le négatif et/ou se rappeler du positif ? Une étude inter-tâches.

A growing number of studies have shown that, compared to young adults, older adults better remember positive information than negative information. However, it is not clear whether this age-related positivity effect relies on an increase in positive information memory and/or on a decrease in negative information memory. Thus, we aimed to study the specific mechanisms underlying the age-related positivity effect in different memory tasks. To do so, we used an emotional word memory paradigm including immediate free recall, recognition and delayed free recall tasks. Forty-five young adults (m = 20.0 years) and 45 older adults (m = 69.2 years) native French speakers participated. Thirty-six low French words, including 12 negative (e.g. égout), 12 positive (e.g. lagune) and 12 neutral (e.g. notion) words were selected from an emotional lexical database (Gobin et al. 2017). For the recognition task, 36 new words were selected. The results showed that the age-related positivity effect specifically depended on a decrease in negativity preference (i.e. the comparison between negative and neutral words) in older adults, in comparison with young adults, both in immediate and delayed free recall tasks. Indeed, in these tasks, young adults recalled more negative than neutral words whereas there was no difference in older adults. In recognition task, no age-related positivity effect has been observed. Moreover, the results showed that, in immediate recall, the higher the older adults memory abilities, the lower their negativity preference. This correlation was not significant in delayed recall. These results suggest that, when compared with young adults, older adults disengage from negative words processing through costly cognitive processes. A small magnitude of negativity preference would indicate good maintenance of memory abilities. Results are discussed in the framework of the socioemotional selectivity theory.

3-D motion capture for long-term tracking of spontaneous locomotor behaviors and circadian sleep/wake rhythms in mouse.

BACKGROUND: Locomotor activity provides an index of an animal's behavioral state. Here, we report a reliable and cost-effective method that allows long-term (days to months) simultaneous tracking of locomotion in mouse cohorts (here consisting of 24 animals). NEW METHOD: The technique is based on a motion capture system used mainly for human movement study. A reflective marker was placed on the head of each mouse using a surgical procedure and labeled animals were returned to their individual home cages. Camera-recorded data of marker displacement resulting from locomotor movements were then analyzed with custom built software. To avoid any data loss, data files were saved every hour and automatically concatenated. Long-term recordings (up to 3 months) with high spatial (<1mm) and temporal (up to 100Hz) resolution of animal movements were obtained. RESULTS: The system was validated by analyzing the spontaneous activity of mice from post-natal day 30-90. Daily motor activity increased up to 70days in correspondence with maturational changes in locomotor performance. The recorded actigrams also permitted analysis of circadian and ultradian rhythms in cohort sleep/wake behavior. COMPARISON WITH EXISTING METHOD(S): In contrast to traditional session-based experimental approaches, our technique allows locomotor activity to be recorded with minimal experimenter manipulation, thereby minimizing animal stress. CONCLUSIONS: Our method enables the continuous long-term (up to several months) monitoring of tens of animals, generating manageable amounts of data at minimal costs without requiring individual dedicated devices. The actigraphic data collected allows circadian and ultradian analysis of sleep/wake behaviors to be performed.

123I-Iodobenzovesamicol SPECT Imaging of Cholinergic Systems in Dementia with Lewy Bodies.

Cholinergic alterations in dementia with Lewy bodies (DLB) have been widely documented in postmortem studies, whereas in vivo studies are sparse, particularly at the subcortical level. We used 123I-iodobenzovesamicol, a SPECT radiotracer of the vesicular acetylcholine transporter, to evaluate in vivo in DLB the integrity of the 3 main cholinergic pathways-the Ch1 (septohippocampal), the Ch4 (innominatocortical), and the Ch5 (pontothalamic) cholinergic pathways-as well as the striatal cholinergic interneurons. In addition, we assessed the involvement of the cholinergic system in cognitive and neuropsychiatric disorders in DLB patients. METHODS: Twelve healthy volunteers (median age, 72 y; interquartile range, 6.25 y) and 11 DLB patients (median age, 76 y; interquartile range, 10.50 y) underwent a dynamic 123I-iodobenzovesamicol SPECT scan and an MRI scan. MR images were automatically segmented, providing the volumes of several regions of interest, including the striatum and cholinergic terminals in Ch1 (hippocampus), Ch4 (cortical lobes), and Ch5 (thalamus). For each region of interest and each subject, pharmacokinetic modeling allowed calculation of the nondisplaceable binding potential (BPND) values for the binding of 123I-iodobenzovesamicol to the vesicular acetylcholine transporter. A neuropsychological evaluation of participants was performed with the Mini-Mental State Examination and the Grober-Buschke, Set, visual discrimination, Benton, and Wechsler tests, and cognitive fluctuations and apathy were also assessed. RESULTS: Compared with BPND values for healthy subjects, BPND values for DLB patients were significantly lower in the Ch4 terminal regions of the anterior cingulate cortex and the superior and inferior parietal cortices (P = 0.0006, 0.0015, and 0.0023, respectively), in the Ch5 terminal region of the thalamus (P = 0.0003), and in the striatum (P = 0.0042). All of the neuropsychological test scores were significantly lower in DLB patients than in healthy subjects. Four DLB patients with apathy and 4 DLB patients without apathy were identified. For the anterior cingulate cortex, compared with BPND values in healthy subjects, BPND values were significantly lower in patients with apathy (P = 0.004) and were unchanged in patients without apathy. CONCLUSION: Our results confirm the existence in DLB of cholinergic alterations, reaching both cortical and subcortical levels, including the Ch5 pathway and the striatum. Alterations in cholinergic transmission in the anterior cingulate cortex could be closely associated with the development of apathy.

Neurosteroids and cholinergic systems: implications for sleep and cognitive processes and potential role of age-related changes.

RATIONALE: The neurosteroids pregnenolone sulfate (PREGS), dehydroepiandrosterone sulfate (DHEAS) and allopregnanolone (3alpha,5alpha THPROG) have been implicated as powerful modulators of memory processes and sleep states in young and aged subjects with memory impairment. As these processes depend on the integrity of cholinergic systems, a specific effect of neurosteroids on these systems may account for their effects on sleep and memory. OBJECTIVE: To review the evidence for a specific and differential effect of neurosteroids on cholinergic systems. METHODS: We carried out keyword searches in "Medline" to identify articles concerning (1) the effects of neurosteroids on cholinergic systems, sleep and memory processes, and (2) changes in neurosteroid concentrations during aging. Few results are available for humans. Most data concerned rodents. RESULTS: Peripheral and central administrations of PREGS, DHEAS, and 3alpha,5alpha THPROG modulate the basal forebrain and brainstem projection cholinergic neurons but not striatal cholinergic interneurons. Local administration of neurosteroids to the basal forebrain and brainstem cholinergic neurons alters sleep and memory in rodents. There are a few conflicting reports concerning the effects of aging on neurosteroid concentrations in normal and pathological conditions. CONCLUSIONS: The specific modulation of basal forebrain and brainstem cholinergic systems by neurosteroids may account for the effects of these compounds on sleep and memory processes. To improve our understanding of the role of neurosteroids in cholinergic systems during normal and pathological aging, we need to determine whether there is specific regionalization of neurosteroids, and we need to investigate the relationship between neurosteroid concentrations in cholinergic nuclei and age-related sleep and memory impairments.

Individual differences in cognitive aging: implication of pregnenolone sulfate.

In humans and animals, individual differences in aging of cognitive functions are classically reported. Some old individuals exhibit performances similar to those of young subjects while others are severely impaired. In senescent animals, we have previously demonstrated a significant correlation between the cognitive performance and the cerebral concentration of a neurosteroid, the pregnenolone sulfate (PREG-S). Neurotransmitter systems modulated by this neurosteroid were unknown until our recent report of an enhancement of acetylcholine (ACh) release in basolateral amygdala, cortex and hippocampus induced by intracerebroventricular (i.c.v.) or intracerebral administrations of PREG-S. Central ACh neurotransmission is known to be involved in the regulation of memory processes and is affected in normal aging and severely altered in human neurodegenerative pathologies like Alzheimer's disease. In the central nervous system, ACh neurotransmission is also involved in the modulation of sleep-wakefulness cycle, and particularly the paradoxical sleep (PS). Relationships between paradoxical sleep and memory are documented in the literature in old animals in which the spatial memory performance positively correlates with the basal amounts of paradoxical sleep. PREG-S infused at the level of ACh cell bodies (nucleus basalis magnocellularis, NBM, or pedunculopontine nucleus, PPT) increases paradoxical sleep in young animals.Finally, aging related cognitive dysfunctions, particularly those observed in Alzheimer's disease, have also been related to alterations of mechanisms underlying cerebral plasticity. Amongst these mechanisms, neurogenesis has been extensively studied recently. Our data demonstrate that PREG-S central infusions dramatically increase neurogenesis, this effect could be related to the negative modulator properties of this steroid at the GABA(A) receptor level. Taken together these data suggest that neurosteroids can influence cognitive processes, particularly in senescent subjects, through a modulation of ACh neurotransmission associated with paradoxical sleep modifications; furthermore, our recent data suggest a critical role for neurosteroids in the modulation of cerebral plasticity, mainly on hippocampal neurogenesis.

Mood Influences the Concordance of Subjective and Objective Measures of Sleep Duration in Older Adults.

OBJECTIVE/BACKGROUND: Sleep plays a central role in maintaining health and cognition. In most epidemiologic studies, sleep is evaluated by self-report questionnaires but several reports suggest that these evaluations might be less accurate than objective measures such as polysomnography or actigraphy. Determinants of the discrepancy between objective and subjective measures remain to be investigated. The aim of this pilot-study was to examine the role of mood states in determining the discrepancy observed between objective and subjective measures of sleep duration in older adults. PATIENTS/METHODS: Objective sleep quantity and quality were recorded by actigraphy in a sample of 45 elderly subjects over at least three consecutive nights. Subjective sleep duration and supplementary data, such as mood status and memory, were evaluated using ecological momentary assessment (EMA). RESULTS: A significant discrepancy was observed between EMA and actigraphic measures of sleep duration (p < 0.001). The magnitude of this difference was explained by the patient's mood status (p = 0.020). No association was found between the magnitude of this discrepancy and age, sex, sleep quality or memory performance. CONCLUSION: The discrepancy classically observed between objective and subjective measures of sleep duration can be explained by mood status at the time of awakening. These results have potential implications for epidemiologic and clinical studies examining sleep as a risk factor for morbidity or mortality.

Anti-S-nitrosocysteine antibodies are a predictive marker for demyelination in experimental autoimmune encephalomyelitis: implications for multiple sclerosis.

Multiple sclerosis (MS) is characterized by inflammation within the CNS. This inflammatory response is associated with production of nitric oxide (NO) and NO-related species that nitrosylate thiols. We postulated that MS patients would exhibit an antibody (Ab) response directed against proteins containing S-nitrosocysteine (SNO-cysteine) and showed that anti-NO-cysteine Abs of the IgM isotype are in fact present in the sera of some MS patients (Boullerne et al., 1995). We report here the presence of a seemingly identical Ab response directed against SNO-cysteine in an acute model of MS, experimental autoimmune encephalomyelitis (EAE) induced in Lewis rats with the 68-84 peptide of guinea pig myelin basic protein (MBP(68-84)). Serum levels of anti-SNO-cysteine Abs peaked 1 week before the onset of clinical signs and well before the appearance of anti-MBP(68-84) Abs. The anti-SNO-cysteine Ab peak titer correlated with the extent of subsequent CNS demyelination, suggesting a link between Ab level and CNS lesion formation. In relapsing-remitting MS patients, we found elevated anti-SNO-cysteine Ab at times of relapse and normal values in most patients judged to be in remission. Two-thirds of patients with secondary progressive MS had elevated anti-SNO-cysteine Ab levels, including those receiving interferon beta-1b. The data show that a rise in circulating anti-SNO-cysteine Ab levels precedes onset of EAE. Anti-SNO-cysteine Abs are also elevated at times of MS attacks and in progressive disease, suggesting a possible role for these Abs, measurable in blood, as a biological marker for clinical activity.

Circadian sleep/wake rhythm abnormalities as a risk factor of a poststroke apathy.

BACKGROUND: Poststroke apathy affects 19-55% of patients following stroke and has a negative impact on functional recovery, general health, and quality of life, as well as being a source of significant burden for caregivers. AIMS: A major clinical issue is the delayed diagnosis of poststroke apathy, and so the aim of our study is to evaluate the relationship between early poststroke alterations of circadian rhythms of sleep/wake cycles and the occurrence of poststroke apathy. METHODS: Forty-six patients with a recent magnetic resonance imaging confirmed stroke were included. Main exclusion criteria were a mild to severe disability impeding home discharge from the hospital and the presence of apathy or dementia before stroke. Cerebrovascular lesions were evaluated by magnetic resonance imaging. At hospital discharge, an actigraph was used to measure patient's global activity as well as parameters of circadian rhythmicity (relative amplitude, interdaily stability, intradaily variability) and sleep (sleep duration, sleep efficiency, fragmentation index) over seven-days. Apathy was assessed at hospital discharge as well as at three-months using the Apathy Inventory and the Lille Apathy Rating Scale. RESULTS: Of the 46 patients evaluated, 10 (22%) showed apathy three-months after stroke (median Apathy Inventory = 4·5). Before inclusion, these 10 subjects did not differ significantly from other patients concerning their sleep and, at inclusion, they did not differ concerning apathy, anxiety, depression, or cognitive and functional abilities. However, actigraphy measured at discharged identified significant alterations of sleep (P < 0·005). Future poststroke apathy patients exhibited a decrease in sleep efficiency (actual sleep time expressed as a percentage of time in bed) and an increase in the fragmentation index (degree of fragmentation during the sleep period) at three-months. No association was observed between poststroke apathy and the characteristics of cerebrovascular lesions (stroke location, extent of leucoencephalopathy, number of lacunes and microbleeds). CONCLUSION: These results indicate that early poststroke alterations of sleep/wake circadian rhythms--easily evaluated by actigraphy--are associated with a higher risk of poststroke apathy at three-months. In terms of clinical outcomes, our results provide targets for very early identification of patients at risk to develop apathy after stroke and for assessing when to start specific therapy to optimize rehabilitation efficiency.

Simplified Quantification Method for In Vivo SPECT Imaging of the Vesicular Acetylcholine Transporter with 123I-Iodobenzovesamicol.

UNLABELLED: (123)I-iodobenzovesamicol is a SPECT radioligand selective for the vesicular acetylcholine transporter (VAChT) and used to assess the integrity of cholinergic pathways in various neurologic disorders. The current noninvasive method for quantitative analysis of (123)I-iodobenzovesamicol, based on multilinear reference tissue model 2 (MRTM2), requires repeated scans for several hours, limiting its application in clinical trials. Our objective was to validate a simplified acquisition method based on a single (123)I-iodobenzovesamicol static scan preserving the quantification accuracy. Three acquisition times were tested comparatively to a kinetic analysis using MRTM2. METHODS: Six healthy volunteers underwent a dynamic SPECT acquisition comprising 14 frames over 28 h and an MR imaging scan. MR images were automatically segmented, providing the volumes of 19 regions of interest (ROIs). SPECT datasets were coregistered with MR images, and regional time-activity curves were derived. For each ROI, a complete MRTM2 pharmacokinetic analysis, using the cerebellar hemispheres as the reference region, led to the calculation of a (123)I-iodobenzovesamicol-to-VAChT binding parameter, the nondisplaceable binding potential (BP(ND-MRTM2)). A simplified analysis was also performed at 5, 8, and 28 h after injection, providing a simplified BP(ND), given as BP(ND-t) = C(ROI) - C(cerebellar hemispheres)/C(cerebellar hemispheres), with C being the averaged radioactive concentration. RESULTS: No significant difference was found among BP(ND-5 h), BP(ND-8 h), and BP(ND-MRTM2) in any of the extrastriatal regions explored. BP(ND-28 h) was significantly higher than BP(ND-5 h), BP(ND-8 h), and BP(ND-MRTM2) in 9 of the 17 regions explored (P < 0.05). BP(ND-5 h), BP(ND-8 h), and BP(ND-28 h) correlated significantly with BP(ND-MRTM2) (P < 0.05; ρ = 0.99, 0.98, and 0.92, respectively). In the striatum, BP(ND-28 h) was significantly higher than BP(ND-5 h) and BP(ND-8 h). BP(ND-5 h) differed significantly from BP(ND-MRTM2) (P < 0.05), with BP(ND-5 h) being 43.6% lower. CONCLUSION: In the extrastriatal regions, a single acquisition at 5 or 8 h after injection provides quantitative results similar to a pharmacokinetic analysis. However, with the highest correlation and accuracy, 5 h is the most suitable time to perform an accurate (123)I-iodobenzovesamicol quantification. In the striatum, none of the 3 times has led to an accurate quantification.